Weight-related discrimination, perceived stress and psychological and physical well-being of persons with type 2 diabetes: A mediation analysis

Abstract

Aims: The aim of the study was to examine perceived stress as a mediator of the association between weight-related discrimination and physical and psychological well-being among persons with type 2 diabetes (T2D).

Methods: Data were obtained from 5104 persons with self-reported T2D participating in the All of Us research programme in the United States. The Everyday Discrimination Scale, Cohen's Perceived Stress Scale (PSS) and PROMIS Global Health Scale were used to measure weight-related discrimination, perceived stress and health outcomes (physical and psychological), respectively. Mediation effects of PSS were tested by bootstrapping with 5000 random samples.

Results: Participants were, on average, 63.62 (SD 11.38) years old. Majority of them were female (55.53%), non-Hispanic White (72.61%), married or living with a partner (56.92%), had a household income of <$35,000 (31.99%) and had some college education (33.54%). We found that approximately 18% of study participants reported having experienced weight-related discrimination. We also found that weight-related discrimination was independently associated with poor physical and psychological well-being. These associations were partially mediated by perceived stress such that weight-related discrimination was associated with greater perceived stress, which was in turn associated with poorer physical and psychological well-being.

Conclusions: Given that weight-related discrimination is associated with poor outcomes through elevated stress, interventions that target stress may disrupt this pathway thereby helping to reduce the health impact of weight-related discrimination. This assertion should, however, be tested in future studies.

Keywords: All of Us research programme; T2D; weight‐related discrimination.

Figure 1.

Hypothesized causal pathway of the effect of weight-related discrimination on psychological and physical wellbeing. The a-path shows the effect of the independent variable on the mediator, b-path shows the effect of the mediator on the outcome variable, the c-path shows the total effect of the independent variable on the outcome variable, and the c’-path shows the direct effect of the independent variable on the outcome variable.

Figure 2.

Path diagram for the mediation analysis. *** indicates p-value < 0.05